scholarly journals GPs’ practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care

2020 ◽  
Vol 70 (698) ◽  
pp. e651-e656
Author(s):  
Kevin Carmody ◽  
Martin Rouse ◽  
Dermot Nolan ◽  
Diarmuid Quinlan
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Questionnaire Survey ◽  
Acne Vulgaris ◽  
Cross Sectional ◽  
Severe Acne ◽  
Irish College ◽  
Pregnancy Testing ◽  
Suboptimal Adherence ◽  
Key Drivers

BackgroundIsotretinoin is prescribed in secondary care for severe acne vulgaris. Anecdotal reports suggest that GPs in Ireland currently initiate isotretinoin.AimTo ascertain the prevalence and management of isotretinoin in Irish general practice and to describe GPs’ attitudes about the use of isotretinoin in Ireland.Design and settingA cross-sectional questionnaire survey of GPs in Ireland between October 2018 and February 2019.MethodTwo short questionnaires were developed: one for GPs who prescribe isotretinoin and one for GPs who do not prescribe isotretinoin. Questionnaires were distributed via email and online via GP Forum to GPs in Ireland.ResultsOf a total 298 GPs who completed the questionnaire, 52 (17%) initiated isotretinoin. Older GPs (aged 35 years) and male GPs were more likely to prescribe isotretinoin. GPs cited prolonged dermatology waiting lists (n = 34, 65%) and a special interest in dermatology (n = 31, 60%) as two key drivers to initiating isotretinoin. However, this study found evidence of suboptimal blood monitoring, pregnancy testing, and contraceptive advice. Most GPs (n = 246, 83%) did not initiate isotretinoin and identified multiple barriers: medicolegal concerns (n = 150, 61%), being unaware that GPs may initiate isotretinoin (n = 135, 55%), and being unfamiliar with managing isotretinoin (n = 102, 41%). Important enablers to initiating isotretinoin cited by GPs include Irish College of General Practitioners guidelines (n = 118, 48%) and dermatologist support (n = 119, 48%). Two-thirds of the GPs questioned (n = 164, 67%) expressed an interest in initiating isotretinoin and most (n = 223, 91%) agreed that GPs can safely manage isotretinoin.ConclusionFew GPs in Ireland currently initiate treatment of acne with isotretinoin, and there is suboptimal adherence to recommended monitoring. Barriers to and enablers for GPs initiating isotretinoin were identified. Most GPs expressed an interest in initiating isotretinoin.

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711053
Author(s):  
Luamar Dolfini ◽  
Yogesh Patel
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acne Vulgaris ◽  
Clinical Information ◽  
Electronic Record ◽  
Self Management ◽  
Considerable Proportion ◽  
Dry Skin ◽  
Record System ◽  
Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

scholarly journals Psychosocial Impact of Acne: A Community Based Cross Sectional Study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Mohammad Sarwar Mir
Keyword(s):  
Quality Of Life ◽  
Social Impact ◽  
Acne Vulgaris ◽  
Clinical Severity ◽  
Age Group ◽  
Cross Sectional ◽  
Severe Acne ◽  
Number Of Patients ◽  
The Impact

Background: It is well-known that acne vulgaris is a common malady of adolescence and is easily recognized Objective: To evaluate the level of impact among acne patients on their quality of life. Methods: A total of 200 patients studied. Acne severity was graded using Global Acne Grading System (GAGS) after the clinical diagnosis. All the patients went through self-administered questionnaire of Cardiff Acne Disability Index (CADI) to fill out, to assess the reflection of patients’ experiences and perceptions. Result: Out of 200 patients, 114(57.0%) were females and 86(43.0%) were males. The maximum number of patients was in the age group of 16-20 years (142/200, 71%). Out of total 86 males, 50 (58.3%) had moderate to severe acne, whereas 62(54.38%) females had such a severe acne. 50.87% (58/114) of females had high CADI scores in comparison to only 27.9(24/86) of males. The impact on quality of life was more in the age-group of 21-30 years even though in this age group clinical severity of acne was mild to moderate only. Conclusion: Study found that individuals with acne had profound emotional, as well as, social impact on their quality of life.

scholarly journals Dosages of androgenic hormones in adolescent patients with severe acne

2020 ◽  
Vol 66 (1) ◽  
pp. 36-41
Author(s):  
Marisa Gonzaga da Cunha ◽  
Caio Moraes ◽  
Giovana Cebrian ◽  
Rafaela Ferreira da Silva ◽  
Sônia Isabel Friedlaender Reple ◽  
...  
Keyword(s):  
Acne Vulgaris ◽  
Adult Life ◽  
Dehydroepiandrosterone Sulfate ◽  
Female Adolescents ◽  
Total Testosterone ◽  
Hormonal Changes ◽  
Cross Sectional ◽  
Severe Acne ◽  
Grade Ii ◽  
Antiandrogen Therapy

SUMMARY OBJECTIVE Acne vulgaris in female adolescents, when severe or accompanied by other signs of androgenization, may represent a sign of hyperandrogenemia often underdiagnosed, which will have harmful consequences for adult life. The objective of this cross-sectional and retrospective study was to demonstrate the incidence of hormonal changes in the cases of female adolescents with severe or extensive acne, with or without other signs of hyperandrogenism, and propose a hormonal research pattern which should be indicated in order to detect early hyperandrogenemia. METHODS The medical records of 38 female patients aged between 9 and 15 years old with grade II and/or III acne were analyzed. The dehydroepiandrosterone sulfate, dehydroepiandrostenedione, and androstenedione, total testosterone, and dihydrotestosterone sulfate hormones were required prior to initiation of treatment. The hormonal dosages were performed in the serum after at least 3 hours of fasting by means of radioimmunoassay tests. RESULTS Of the 38 patients included, 44.7% presented changes in androgen levels (hyperandrogenemia), and the two most frequently altered hormones were DHEA and androstenedione, with the same incidence (23.6%). CONCLUSIONS The correct and early diagnosis provides an effective and agile approach, including antiandrogen therapy, with the purpose of avoiding the reproductive and metabolic repercussions, besides controlling the inflammatory picture and avoid aesthetic complications.

scholarly journals Hubungan antara Mencuci Wajah dengan Kejadian Akne Vulgaris pada Remaja Laki-laki di Manado

e-CliniC ◽  
2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Fifin R. T. Sole ◽  
Pieter L. Suling ◽  
Tara S. Kairupan
Keyword(s):  
Propionibacterium Acnes ◽  
Acne Vulgaris ◽  
Adolescent Males ◽  
Personal Hygiene ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Severe Acne ◽  
Akne Vulgaris ◽  
The Relationship

Abstract: Acne vulgaris is a chronic skin condition involving inflammation of the pilosebaceous follicle. The highest prevalence of acne vulgaris is at the age of 16-17 years. Pathogenic factors contributing to the development of acne vulgaris include increased sebum production, pilosebaceous follicular blockage, and increased colonization of Propionibacterium acnes. Personal hygiene is suggested as an important factor that needs to be maintained in acne prevention. Males tend to lack of awareness to seek information and health services in dealing with acne problems. This study was aimed to evaluate the relationship between facial washing and the incidence of acne vulgaris in adolescent males in Manado. This was an analytical and observational study using a cross-sectional design. Subjects were male students of 3rd grade at SMA Negeri 9 Manado, aged 16-19 years old, and met the inclusion and exclusion criteria, with a total number of 95 students. Subjects who washed their faces 2-3 times a day were 38 students (40%) while those who washed their faces less than twice or more than thrice a day were 57 students (60%). Subjects with no or mild acne vulgaris were 39 students (41.1%), while those with moderate to severe acne vulgaris were 56 students (58.9%). The chi-square showed a p-value of 0.004 for the relationship between the frequency of facial washing and the incidence of acne vulgaris. In conclusion, there was a significant relationship between facial washing and the incidence of acne vulgaris in adolescent males in Manado.Keywords: facial washing, acne vulgaris Abstrak: Akne vulgaris merupakan peradangan kronis folikel pilosebasea dengan prevalensi tertinggi pada usia 16-17 tahun. Faktor yang memengaruhi terjadinya akne vulgaris antara lain peningkatan produksi sebum, penyumbatan folikel pilosebasea, dan peningkatan kolonisasi bakteri Propionibacterium acnes. Kebersihan diri merupakan faktor penting yang perlu dijaga sebagai salah satu usaha untuk mencegah timbulnya akne. Laki-laki cenderung kurang memiliki kesadaran untuk mencari informasi dan pelayanan kesehatan dalam menangani masalah akne. Penelitian ini bertujuan untuk menilai hubungan antara mencuci wajah dengan kejadian akne vulgaris pada remaja laki-laki di Manado. Jenis penelitian ialah observasional analitik dengan desain potong lintang. Subjek penelitian ialah siswa laki-laki kelas 3 di SMA Negeri 9 Manado, usia 16-19 tahun, dan memenuhi kriteria inklusi dan eksklusi, dengan jumlah total 95 siswa. Subjek yang mencuci wajah 2-3 kali sehari sebanyak 38 siswa (40%) sedangkan yang mencuci wajah kurang dari 2 kali atau lebih dari 3 kali sehari sebanyak 57 siswa (60%). Subjek tanpa akne vulgaris atau akne derajat ringan sebanyak 39 siswa (41,1%) sedangkan yang dengan akne vulgaris derajat sedang sampai berat sebanyak 56 siswa (58,9%). Uji chi-square memperlihatkan nilai p=0.004 terhadap hubungan antara frekuensi mencuci wajah dengan kejadian akne vulgaris. Simpulan penelitian ini ialah terdapat hubungan bermakna antara mencuci wajah dengan kejadian akne vulgaris pada remaja laki-laki di Manado.Kata kunci: mencuci wajah, akne vulgaris

scholarly journals Assessing of the Risk Factor & Determine Epidemiology of Acne Vulgaris in Tertiary Care Teaching Hospital

2021 ◽  
pp. 261-271
Author(s):  
Rajesh Hadia ◽  
Idrisi Mohammed Tousif ◽  
Avani Kapadia ◽  
Suchitra Pillai ◽  
Hemraj Singh Rajput ◽  
...  
Keyword(s):  
Acne Vulgaris ◽  
Seborrheic Dermatitis ◽  
Tertiary Care ◽  
Study Data ◽  
Cross Sectional ◽  
Severe Acne ◽  
Factor Determine ◽  
History Of ◽  
The Common ◽  
Social Habits

Background: Acne vulgaris remains one of the commonest diseases to afflict humanity, with over 90% of males and 80% of females affected by the age of 21 years. Objectives: The aim of this study was to assessing the specific risk factors, determine the epidemiology and etiology of Acne Vulgaris. Methodology: It is a cross-sectional observational study conducted for a period of six month in the department of dermatology, Dhiraj General Hospital, Vadodara. Patients who were diagnosed with acne vulgaris and fulfilled the inclusion criteria were enrolled in the study. Data was collected by filling the patient medical record sheet. Result: Total 300 patients were included in the study. Out of which 38.67% males and 61.33% females were found affected by Acne Vulgaris. The mean age group affected were found to be 21.77±4.06 years. When compared their social habits, patients consumed more caffeine (49.67%) than alcohol (24.67%), smoking (15.33%) and tobacco (5.67%). 32.33% patients also had history of seborrheic dermatitis. Using GAGS scale, we found 94% patients suffered from moderate Acne condition while 6% suffered from severe Acne condition. Conclusion: Acne Vulgaris was predominantly found in females in adolescence and in males in adulthood. The severity was found more in males than females. The common site for Acne Vulgaris was found to be face while comedones and papules were the common types of lesions. Stress was found to be one of the major aggravating factors for severity of Acne Vulgaris.

scholarly journals Challenges of diagnosing and managing polymyalgia rheumatica: a multi-methods study in UK general practice

2018 ◽  
Vol 68 (676) ◽  
pp. e783-e793 ◽  
Author(s):  
Toby Helliwell ◽  
Sara Muller ◽  
Samantha L Hider ◽  
Irena Zwierska ◽  
Sarah Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Polymyalgia Rheumatica ◽  
Questionnaire Survey ◽  
Response To Treatment ◽  
Older Individuals ◽  
Current Guidance ◽  
The Uk ◽  
Ongoing Monitoring ◽  
Rule Out

BackgroundPolymyalgia rheumatica (PMR) is one of the most common inflammatory arthritic disorders seen in older individuals. Most patients with PMR are diagnosed and managed exclusively in general practice, yet primary care-focused research is lacking.AimTo identify and explore the challenges of diagnosis and management of PMR in general practice.Design and settingA multi-methods study in UK primary care.MethodThe multi-methods study comprised two complementary studies: a national questionnaire survey of 5000 randomly selected GPs from across the UK; and a qualitative semi-structured telephone interview study of UK GPs. Simple descriptive statistics were used to analyse questionnaire data. A thematic approach was used to analyse verbatim transcripts of the GP interviews.ResultsIn total, 1249 (25%) GPs responded to the questionnaire survey. From this total, 24 GPs were interviewed for the qualitative study. Features used by GPs to identify PMR were largely in line with current guidance. Diagnosis was found to be challenging, with GPs relying heavily on response to treatment with glucocorticoids. Investigations advised by current British PMR guidance to attempt to rule out other causes for symptoms were not routinely requested. Concerns surrounding ongoing treatment with glucocorticoids were widespread in relation to both potential adverse effects and ongoing monitoring.ConclusionFocused strategies to investigate and therefore exclude non-PMR differential diagnoses are required for patients with new-onset suspected PMR symptoms. Additionally, ongoing active review for alternative causes for symptoms as well as vigilance for treatment complications needs to be implemented.

scholarly journals Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets

2018 ◽  
Vol 13 (3) ◽  
pp. 145-158 ◽  
Author(s):  
Emma Davies ◽  
Ceri Phillips ◽  
Jaynie Rance ◽  
Berni Sewell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Large Scale ◽  
Study Cohort ◽  
Age Group ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Adult Age ◽  
Opioid Prescribing ◽  
Strong Opioid

Objectives: To examine trends in strong opioid prescribing in a primary care population in Wales and identify if factors such as age, deprivation and recorded diagnosis of depression or anxiety may have influenced any changes noted. Design: Trend, cross-sectional and longitudinal analyses of routine data from the Primary Care General Practice database and accessed via the Secure Anonymised Information Linkage (SAIL) databank. Setting: A total of 345 Primary Care practices in Wales. Participants: Anonymised records of 1,223,503 people aged 18 or over, receiving at least one opioid prescription between 1 January 2005 and 31 December 2015 were analysed. People with a cancer diagnosis (10.1%) were excluded from the detailed analysis. Results: During the study period, 26,180,200 opioid prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9% non-cancer diagnoses). The greatest increase in annual prescribing was in the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000 population, although the 85+ age group had the highest prescribing rates across the study period (from 149.9 to 288.5 prescriptions/1000 population). The number of people with recorded diagnoses of depression or anxiety and prescribed strong opioids increased from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in areas of highest deprivation compared to 310.3 in the least. Areas of greatest deprivation had more than twice the rate of strong opioid prescribing than the least deprived areas of Wales. Conclusion: The study highlights a large increase in strong opioid prescribing for non-cancer pain, in Wales between 2005 and 2015. Population groups of interest include the youngest and oldest adult age groups and people with depression or anxiety particularly if living in the most deprived communities. Based on this evidence, development of a Welsh national guidance on safe and rational prescribing of opioids in chronic pain would be advisable to prevent further escalation of these medicines. Summary points This is the first large-scale, observational study of opioid prescribing in Wales. Over 1 million individual, anonymised medical records have been searched in order to develop the study cohort, thus reducing recall bias. Diagnosis and intervention coding in the Primary Care General Practice database is limited at input and may lead to under-reporting of diagnoses. There are limitations to the data available through the Secure Anonymised Information Linkage databank because anonymously linked dispensing data (what people collect from the pharmacy) are not currently available. Consequently, the results presented here could be seen as an ‘intention to treat’ and may under- or overestimate what people in Wales actually consume.

Sign in / Sign up

Export Citation Format

Share Document